Please give personal references that are not relatives or former employers.

First Reference

Name:

Address, City, State:

Daytime Phone:

Second Reference

Name:

Address, City, State:

Daytime Phone:

Third Reference

Name:

Address, City, State:

Daytime Phone:

MISCELLANEOUS

Additional Comments

The space below is provided for any additional comments you wish to submit with your application.

May we contact your current employer?

Yes
No

May we contact your past employers?

Yes
No

Felony/Misdemeanor Information

Have you ever been convicted of a felony or misdemeanor (either civilian or military)?

Yes
No

Number of Convictions:

Your convictions were for:

Felony
Misdemeanor
Both
Unsure

First Conviction

Date of Conviction:

State/County of Conviction:

Charges:

Second Conviction

Date of Conviction:

State/County of Conviction:

Charges:

Third Conviction

Date of Conviction:

State/County of Conviction:

Charges:

Enter below any additional information that you deem important regarding the above convictions and information regarding any additional convictions you may have.

Please select a business area of interest. (Multiple areas may be selected by holding the CTRL key and clicking the options.)

In which Farmers Home Furniture location would you like to work? (Multiple locations may be selected by holding the CTRL key and clicking the options.)

BEFORE SUBMITTING, PLEASE READ and RESPOND BY CHECKING THE BOX BELOW.

In submitting this application for employment, I understand that Farmers Home Furniture / Farmers Furniture / Warehouse Home Furnishings Distributors, Inc. (hereinafter referred to as the Company) may investigate my driving history and criminal history, if any, and that an investigative consumer report may be made.

I authorize former and present employers, work and personal references, listed in this application, and any other individuals I may name, to give the Company and its designee any and all information they may have, personal or otherwise, and release such parties from all liability that may result from furnishing same.

I understand that this employment application and other Company documents are not promises of employment, and should I accept employment, I understand that my employment will be at will and may be terminated with or without notice at any time at my option or at the option of the Company. I understand that only a written agreement expressing contrary signed by me and by the President of the Company can vary this employment at will policy.

I certify that the information I have provided herein is true and complete, and I understand that any misrepresentation or omission of fact is cause for rejection of my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.

Check the following box to indicate if have read and agree to the above statement.

Please proofread your answers carefully. If any information is missing or invalid, we may not be able to process you application.

EQUAL EMPLOYMENT OPPORTUNITY STATEMENT

It is the policy of Farmers Home Furniture / Farmers Furniture / Warehouse Home Furnishings Distributors, Inc. to recruit, train, hire, promote and otherwise deal with all applicants and employees without regard to race, color, religion, gender, national origin, age, physical or mental disability, marital status or status as a Vietnam-era veteran or disabled veteran.

This data is for the sole purpose of employment opportunities and will be used and distributed only within the Farmers Home Furniture organization. Only candidates selected for interviews will be contacted. Your resume will be kept on file for active reference for a period of 6 (six) months.